Consultation Response – “Paying for Care in Wales”
Author:Dr Paul Tromans, Director of Health and Social Care Quality
Date:1st March 2010 / Version:1
Publication/ Distribution: Public Health Wales(Internet)
Review Date:Not applicable
Purpose and Summary of Document:
This report represents the response of Public Health Wales to the consultation document “Paying for Care”.Although the title of the consultation document suggests the Green Paper is focusing on the financial aspects of care the paper also invites comments on the general organisation of social services and Public Health Wales responses are therefore grouped into two categories covering these two separate, but related, issues.
Work Plan reference: Not applicable
Date:1 March 2010 / Version:1 / Page: 1 of 4
Public Health Wales / Consultation Response – “Paying for Care”
1Purpose of Report
This report represents the response of Public Health Walesto the consultation document “Paying for Care in Wales”.
Although the title of the Green Paper document suggests it is a consultation on the financial aspects of careprovision the report also invites comments on the general organisation/direction of social services. The Public Health Wales response is therefore grouped into two headings covering these two separate but related issues.
2Public Health Wales Comments on “Transforming Social Services in Wales”
Social services are an integral component of services that promote public health and wellbeing and, as such, this should feature as a key component of the strategic vision. Public Health Wales would strongly agree with the rebalancing towards prevention and earlier intervention, with services being more proactive, evidence based and focused on recovery, re-ablement and social inclusion.
The Green Paper asserts that integrated social services authorities rooted in local government are the way forward. Now that Wales has new integrated healthcare bodies Public Health Wales believes that consideration should be given, in due course, to the case for integrating the provision of health and social care through the creation of new health and social care bodies.
Health and Social Care priorities on key strategic areas need be in tandem to avoid the development of perverse incentives. These can leave the service users in complex and unhelpful positions (examples of these can be seen in Ombudsmen reports).
Public Health Wales believes there is a need to strengthen joint working not only with the NHS and other partners, but also through national and local policies and guidance ensuring priorities across services are consistent. To ensure that integrated health and social care is achieved Public Health Walesbelieves that emerging evidence based methods of joint working should not necessarily be optional, but form part ofthe statutory guidance to local authorities.
The integration of social care and health services for the frail elderly (e.g.district nursing and home care) is but one of a number of areas that would benefit from the production of new models of joint working based around emerging evidence.
Public Health Wales believes that models of care for the elderly based on the concept of social enterprise, e.g. community co-operatives, are worthy of further exploration.
Any transformation of social services should provide increased leverage for an improvement in value for money and quality in residential and nursing homes.
With regard to charging policies,inconsistency across Waleshas led to inequalities. Any charging policy should be established on an all Wales basisand be underpinned with equity of access and quality standards for the provision of care.
3Public Health WalesComments on Paying for Care
The comments in this section are focused primarily around the issue of health inequalities, and equity in provision of care, which form key strands of public health engagement with partner organisations.
Public Health Wales believes that policy on paying for care should be prefaced by a very clear statement on the rights of those with a need for care. The policy should be driven by a commitment to deliver a high quality service in a framework of equity, rather than be driven simply by the necessities of the current economic difficulties. Public Health Wales recognises that the issue of paying for care is complex, but is concerned that the issues are being considered in isolation of issues of wider economic policy.
Public Health Wales believes there is a central role for the state in the funding of care for elderly and disabled people. Solutions that do not recognise this are likely to have an adverse effect on population health and increase health inequalities, and inequity, in Wales.
Whatever model is adopted, it needs to be able to meet predicted levels of need. However, Public Health Wales would challenge the underlying assumption in the Green Paper that an ageing population will necessarily lead to higher levels of dependency and long-term care. More needs to be done through adopting innovative preventative and early therapeutic approaches towards the development of frailty, in order to ensure longer duration of independent living.
In general terms, Public Health Wales argues that from the health inequalities perspective it would be desirable if funding for social care was based,at least in part, on taxation so that all citizens, including retired people, contribute according to their means.If the full costs of care cannot be made from taxation (which is the likely scenario),then a range of partnership options should be made available to people, withindividual contributions assessed on ability to pay. Wales would need to receive a proportionate amount of any revenue generated to enable it to meet the needs of its population.
The options that are presented may not reflect the full range of possibilities in this area and Public Health Wales believes that some emerging novel and innovative approaches (often involving the third sector) should be considered.
Public Health Walesrecommends that there is equivalence of charging systems across England and Wales. From apublic health perspective it would not be desirable for individuals to migrate from Wales to England (or vice versa), if differences in the charging system made this an attractive option from a purely financial perspective.
With regard to the issue of integration of social security benefits into the social care funding system, there will be a need to simplify the existing system. Notably it is a decision for the UK Government, whose view will undoubtedly influence the situation pertaining to Wales. Moreover the existing Social Security benefits identify the more severely disabled. Those with less severe disabling impairments of body and/or mind may not accrue existing benefits and therefore unless accommodated by well be left at a disadvantage. Public Health Wales is aware that the complexity and number of forms that need to be completed, in order to access help need to be reviewed radically.
Date:1 March 2010 / Version:1 / Page: 1 of 4